Clubbing of Fingers: Causes, Grading, and Clinical Significance

Clubbing of Fingers: Causes, Grading, and Clinical Significance

Question. Write a short note on clubbing.

Answer. Clubbing is an enlargement of the distal segment of fingers and toes due to an increase in soft tissue.

Causes of Clubbing

1. Pulmonary disorders

1. Suppuration of lung
   • Bronchiectasis
   • Lung abscess
   • Suppurative pneumonia
2. Tumors of lung
   • Mesothelioma
   • Primary lung cancer
   • Metastatic lung cancer

2. Cardiac disorders

Clubbing of Fingers: Causes, Grading, and Clinical Significance

• Cyanotic congenital heart diseases
• Subacute bacterial endocarditis
• Atrial myxoma

3. Disorders of the gastrointestinal system and liver

1. Inflammatory bowel disease
   • Regional ileitis
   • Ulcerative colitis
   • Malabsorption syndrome
2. Cirrhosis of liver
3. Malignancy of liver

4. Disorders of endocrine system

• Myxedema
• Thyroid acropachy
• Acromegaly

5. Miscellaneous

• Hereditary Idiopathic
• Unilateral: Pancoast tumor, subclavian and innominate artery aneurysm
• Unidigital: Traumatic or tophi deposit in gout
• Only in upper limbs in heroin addicts due to chronic obstructive phlebitis.

Clinical Significance of Clubbing of Fingers

Grading

• Grade I: Softening of nail bed due to the hypertrophy of tissue at that particular site.
• Grade II: In addition to grade I changes there is the obliteration of the angle of the nail bed
• Grade III: In addition to grade II changes there is swelling of the subcutaneous tissues over the base of the nail causing the overlying skin to become tense, shiny, and wet and increasing the curvature of the nail, resulting in parrot beak or drumstick appearance.
• Grade IV: Swelling of the fingers in all dimensions associated with hypertrophic pulmonary osteoarthropathy causing pain and swelling of the hand, wrist, etc., and radiographic evidence of subperiosteal new bone formation.